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No description available.

Military veterans and active-duty service members face high rates of posttraumatic stress disorder (PTSD), a chronic and debilitating condition that is comorbid with other negative psychological and social outcomes. PTSD symptomology in military careers is attributed to unique organizational factors and risks both during and post-deployment. Delivering modern, effective PTSD treatments derived from evidence-based research to the military population is a multi-faceted effort. Among these interventions, prolonged exposure therapy (PE) is a safe and effective trauma-focused treatment for veterans. To yield higher rates of PE success, common challenges faced by both military clients and their clinicians that may be impairing adoption were examined in this systematic review of 136 articles. While military clients face challenges related to treatment access and retention, clinicians entrusted to administer PTSD treatment report limited training and skepticism towards PE as barriers. When these complex barriers converge, PE, while shown successful at reducing PTSD symptomology in randomized controlled trials, may fail to achieve positive outcomes. To aid current understanding of this multi-level issue, a systematic review of existing client and clinician studies was conducted to synthesize common problems and facilitators to PE implementation. Findings suggest that low treatment readiness, complex symptom presentations, and time conflicts remain significant barriers. Providers could benefit from increased organizational support and training while clients experience better treatment retention and outcomes when a strong therapeutic alliance and social support is present.

The current study takes an initial step toward deriving a method for empirically based, theory-driven treatment matching in a military population suffering from PTSD. Along with the more overt symptoms of PTSD (e.g., persistent hyperarousal), secondary cognitive symptoms have also been shown to be significantly associated with avoidance and intrusive symptoms, as well as contribute to functional impairment. Based on the factor analytic and treatment literature for PTSD, it appears that there are two central mechanisms associated with beneficial therapeutic change that underlies both CPT and PE treatments (i.e., habituation, changes in cognitions). Additionally, different traumatic events and peritraumatic responses may be associated with unique symptom profiles and may necessitate targeted treatment. The present study proposes a novel approach to treatment matching based on the factor structure of PTSD and underlying mechanisms of treatment response. More broadly, this paper provides evidence for a broader understanding of peritraumatic responses and the potential implications of these responses for symptom profiles and illness trajectories.